Mumbai Knee Foot Ankle clinic & Sir HN Reliance foundation hospital, Prarthana samaj, Girgaon, Mumbai-400004, India.
Department of Orthopaedics, Mahatma Gandhi Mission Institute of Medical Sciences, Kamothe, Navi-Mumbai 410209, Maharashtra, India.
Foot (Edinb). 2021 Dec;49:101833. doi: 10.1016/j.foot.2021.101833. Epub 2021 Oct 20.
Tibio-talo-calcaneal (TTC) fusion is a successful surgery for Charcot neuropathy affecting the hindfoot. A case series of Charcot neuropathy is presented with almost complete loss affecting hindfoot treated with tibio-talo-calcaneal nail.
Seven patients with Charcot neuropathy of the hindfoot having varying degrees of talus loss underwent tibio-talo-calcaneal nailing between January 2014 and Feb 2016 at a tertiary care hospital by a single surgeon. All the patients were type 3a as per Brodsky classification. Patients with active infection, fractures and avascular necrosis of talus was excluded from the study. The final outcome was measured using the AOFAS and FADI scores at the end of 2 years.
The mean duration of diabetes was 8.16 ± 3.12 years. Two patients (28.6%) had total and 5 (71.4%) patients had subtotal talus loss. Anterior approach was used in four, and lateral approach was used in three cases respectively. The talus was reconstructed by using the iliac crest or the graft from the distal fibula wherever appropriate. The average surgical duration was 93.28 ± 4.84 min. One patient had deep infection, 2 years after the surgery which was treated by implant removal and antibiotics. No patients had non-union. The pre-operative AOFAS scores improved from 32.2 ± 2.58 to 73.4 ± 3.36 at 2-year follow-up (p < 0.0001). Similarly, the pre-operative FADI scores were 31.74 ± 1.98 which improved to 65.94 ± 3.68 at the end of 2 years (p < 0.0001).
Retrograde tibio-talo-calcaneal nail is a good option for limb salvage in patients with severe talus loss with good functional outcome.
Therapeutic IV.
距下关节（TTC）融合术是治疗跟骨后足夏科氏神经病的一种成功手术。本文报告了一组夏科氏神经病病例，这些患者后足几乎完全丧失，采用胫距跟骨钉治疗。
2014 年 1 月至 2016 年 2 月，在一家三级保健医院，一位外科医生对 7 例夏科氏神经病后足有不同程度距骨丧失的患者进行了胫距跟骨钉治疗。所有患者均按 Brodsky 分类为 3a 型。患有活动性感染、骨折和距骨缺血性坏死的患者被排除在研究之外。2 年后，使用 AOFAS 和 FADI 评分来测量最终结果。
糖尿病的平均病程为 8.16 ± 3.12 年。2 例（28.6%）患者为完全距骨丧失，5 例（71.4%）患者为部分距骨丧失。前入路 4 例，侧入路 3 例。根据需要，使用髂嵴或腓骨远端移植物重建距骨。平均手术时间为 93.28 ± 4.84 分钟。1 例患者在术后 2 年发生深部感染，经植入物取出和抗生素治疗。无患者发生骨不连。术前 AOFAS 评分从 32.2 ± 2.58 提高到 2 年随访时的 73.4 ± 3.36（p < 0.0001）。同样，术前 FADI 评分从 31.74 ± 1.98 提高到 2 年随访时的 65.94 ± 3.68（p < 0.0001）。
逆行胫距跟骨钉是治疗严重距骨丧失患者保肢的良好选择，可获得良好的功能结果。
治疗性 IV 级。
